The hospice nurse is working with a volunteer.
Which task could the nurse delegate to the volunteer?

Managing hyperkalemia and burn injuries necessitates rapid assessment and specialized intervention. Understanding the electrophysiology of the heart and the mechanical pressure exerted by burned skin allows nurses to intervene effectively to stabilize cardiac rhythms and maintain peripheral pulses and perfusion.

Choice A rationale

Potassium supplements would exacerbate hyperkalemia, further increasing the extracellular potassium concentration. This would worsen cardiac membrane depolarization, potentially leading to fatal ventricular arrhythmias or asystole. Normal serum potassium levels range from 3.5 to 5.0 mEq/L.

Choice B rationale

Continuous cardiac monitoring is vital because hyperkalemia alters the myocardial resting membrane potential. This can lead to peaked T waves, widened QRS complexes, and cardiac arrest. Constant surveillance allows for immediate detection of life-threatening electrical changes.

Choice C rationale

Calcium gluconate is administered to stabilize the cardiac cell membrane. It does not lower potassium levels but antagonizes the cardiotoxic effects of hyperkalemia by increasing the threshold potential, thereby reducing the risk of lethal arrhythmias.

Choice D rationale

Hemodialysis is the most definitive and rapid method to remove excess potassium from the blood. It is indicated in severe, symptomatic hyperkalemia when medical therapies are insufficient to stabilize the patient or clear the electrolyte.

Choice E rationale

While diuretics like furosemide can increase potassium excretion, they are often too slow for emergency stabilization in severe hyperkalemia with arrhythmias. They require adequate renal perfusion and function, making them a secondary rather than primary intervention.

Delegating tasks to unlicensed personnel after spinal surgery requires knowledge of postoperative safety protocols. Applying principles of spinal immobilization and proper body mechanics is crucial to prevent vertebral misalignment, spinal cord injury, or surgical site complications during early mobilization phases.

Choice A rationale

Reporting a pain level of 6/10 is an appropriate action for unlicensed personnel as they are expected to communicate patient status to the nurse. This does not warrant intervention because it demonstrates adherence to reporting protocols for pain management.

Choice B rationale

Offering oral fluids is generally acceptable for postoperative clients once they are alert and have positive bowel sounds or gag reflexes. Unless the client is strictly NPO, this basic care task is within the scope of unlicensed assistive personnel.

Choice C rationale

Repositioning a spinal surgery client using a draw sheet and additional assistance is a safe method to ensure the spine remains neutral. This prevents shearing forces and maintains alignment, making it an appropriate action for the staff member.

Choice D rationale

Assisting a client to sit without logrolling risks twisting the spinal column, which can cause permanent nerve damage or dehiscence. Clients must be moved as a single unit to maintain neutral alignment during all movements following spinal surgery.